Original Notice.

     Preproposal statement of inquiry was filed as WSR 03-02-063 and 02-17-068.

     Title of Rule: Chapter 388-820 WAC.

WAC	Caption	Purpose of Proposed Rule
388-820-020	What definitions apply to this chapter?	Added definitions to address crisis diversion services and state supplemental payment (SSP).
388-820-030	What are residential services?	Added the term "instruction" to accurately reflect the services provided.
388-820-050	Where are residential services provided?	Added the term "instruction" to accurately reflect the intent of residential services.
388-820-056 (new)	Where are crisis diversion services provided?	This new WAC is added to include crisis services under certification.
388-820-060	Who may receive residential services?	Added SSP reference.
388-820-070	What physical and safety requirements exist for residential services?	Crisis diversion services offered in client's home are exempted.
388-820-076 (new)	How must service providers assist clients in regulating water temperature?	This section provides specific guidelines for service providers when they are assisting clients to maintain a safe hot water temperature. It is a specific safety requirement.
388-820-086 (new)	What are crisis diversion services?	Explains the service.
388-820-090	What are group homes?	Housekeeping changes.
388-820-100	When must a service provider document a client's refusal to participate in services?	WAC reference corrected.
388-820-120	Who pays for a client's residential services?	SSP reference added.
388-820-230	May a service provider receive provisional certification?	Clarified the intent of the WAC.
388-820-260	Must service providers' administrative documents be approved by DDD?	Relaxed the requirement by removing some of the policies that must be approved by DDD.
388-820-290	What staffing requirements must service providers meet?	Changed reference from funds to hours.
388-820-300	May clients instruct and support other clients?	Clarified the role of clients in crisis diversion services.
388-820-310	Do employees and volunteers need background checks?	Reworded this WAC to reflect the current practice in place.
388-820-320	What are the minimum requirements for staff employed by service providers?	Date corrected.
388-820-330	What staff training is required?	Housekeeping changes.
388-820-340	How often must performance reviews be conducted for staff of service providers?	Relaxed the requirement.
388-820-350	When must service providers have staff-coverage schedules approved by DDD?	Replaced funding by staff coverage.
388-820-400	What information do service providers need to keep in client records?	Added crisis diversion reference.
388-820-405 (new)	What information do crisis diversion service providers need to keep in client's records?	New section includes information for crisis diversion services.
388-820-410	Do service providers need to keep client's property records?	Exempted crisis diversion service providers.
388-820-550	How often must the ISP be reviewed?	Housekeeping changes.
388-820-555 (new)	What plans must crisis diversion service providers develop?	Clarifies information on the plan.
388-820-560	What is an individual instruction and support plan (IISP) for clients?	Housekeeping changes.
388-820-600	May a service provider hold bankbooks and bankcards for a client?	Made the rule more general.
388-820-650	What documentation must service providers keep to protect a client's financial interests?	Made the rule more specific by clarifying the WAC.
388-820-690	What must service providers do to support a client's health?	Increased the scope by moving two services from other part of the chapter.

     Purpose: The Division of Developmental Disabilities (DDD) is amending rules to specify health and safety standards that service providers must meet to support clients in mental health crisis diversion services. The rules also specify training requirements for staff working with clients in these settings and administrative responsibilities of the contractor. The standards will ensure provision of supports to client in DDD-contracted mental health crisis diversion services that are consistent with the division's philosophy of community supports and establish standards for monitoring these services. The standard added regarding safety features is to also clarify requirements for providers regarding the health and safety of clients receiving community residential services and support services. DDD also proposes revisions to: Correct errors in rules adopted as WSR 01-22-020; clarify the language of the rules; and clarify requirements for providers.

     Statutory Authority for Adoption: RCW 71A.12.030.

     Statute Being Implemented: Chapter 71A.12 RCW.

     Summary: The proposed rules add mental health crisis diversion services as part of DDD certified services. This will allow DDD to monitor the services and ensure that providers meet the requirements of their contract. It adds specifics for providers to assist clients in regulating water temperature in the client's homes. Some amendments are made to correct errors from the last revision.

     Reasons Supporting Proposal: The proposed rules provide oversight for mental health crisis diversion services and adds specifics for safeguarding client health and safety.

     Name of Agency Personnel Responsible for Drafting and Implementation: Saif Hakim, P.O. Box 45310, Olympia, WA 98504, (360) 902-0263; and Enforcement: Rita Dickey, P.O. Box 45310, Olympia, WA 98504, (360) 902-8451.

     Name of Proponent: Department of Social and Health Services, governmental.

     Rule is not necessitated by federal law, federal or state court decision.

     Explanation of Rule, its Purpose, and Anticipated Effects: See Title of Rule, Purpose, Summary, and Reasons Supporting Proposal above. It is anticipated that the change in rules would provide guidance for service providers who offer mental health crisis diversion services. It will also provide monitoring by the state on regular basis for these services. It improves the safety standards and removes some of the redundant requirements that service providers currently have to meet.

     Proposal Changes the Following Existing Rules: See Title of Rule, Purpose, Summary, and Reasons Supporting Proposal above.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. There are no new costs associated with the addition of the new rules. Also, the existing rules that are amended do not have a fiscal impact on service providers.

     RCW 34.05.328 applies to this rule adoption. The department has determined that the proposed rules meet the definition of a "significant legislative rule." An evaluation of the probable costs and benefits of the proposed rules has been prepared, and is available by contacting the person listed above.

     Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on November 25, 2003, at 10:00 a.m.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by November 21, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

     Submit Written Comments to: Identify WAC Numbers, Rules Coordinator, DSHS Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., November 25, 2003.

     Date of Intended Adoption: Not earlier than November 26, 2003.

October 3, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     "Certification" means the determination by DSHS that an agency or service provider has satisfactorily complied with the requirements outlined in this chapter and in the department contract.

     "Client" means a person who((:

     •)) has a developmental disability((;

     •)) and is eligible under RCW 71A.10.020((; and

     • Is authorized by DDD to receive residential services outlined in this chapter)). (For eligibility criteria, see chapter 388-825 WAC and WAC 388-820-060.)

     "Client services" means instruction and support activities that benefit clients, as specified under WAC 388-820-450 through 388-820-510.

     "Community alternatives program (CAP)" means a Title XIX Medicaid waiver program that serves a specific number of individuals. This waiver is for particular home- and community-based services not covered under the Medicaid state plan. (See WAC 388-825-170 for more details.)

     "Community protection services" (Community Protection Intensive Supported Living Services, or CP-ISLS) means intensive supported living services provided to clients who meet the criteria of "Individual with Community Protection Issues."

     "Crisis diversion services (CDS)" means DDD-authorized crisis residential services and supports offered to clients on a temporary basis. These clients show a serious decline in mental functioning, making the client at risk for psychiatric hospitalization (see WAC 388-820-050 and 388-820-085 for details).

     "Crisis service plan" refers to a document that identifies needs and services a client will receive while placed in crisis diversion services.

     "DDD" refers to the division of developmental disabilities at DSHS.

     "DSHS" refers to the department of social and health services of Washington state.

     "Exceptions" means DSHS' approval of a written request for an exception to a rule in this chapter. (There are no exceptions to RCWs.)

     "Group home" means residential services provided in a dwelling that is:

     ((•)) (1) Owned, leased, or rented by an entity other than the client;

     ((•)) (2) Licensed by the applicable state authority; and

     ((•)) (3) Operated by a provider.

     (See WAC 388-820-090 for further details.)

     "Group training home" means a certified nonprofit residential facility that provides full-time care, treatment, training, and maintenance for clients, as defined under RCW 71A.22.020(2).

     "IFP" refers to individual financial plan. (See WAC 388-820-620.)

     "IISP" refers to the individual instruction and support plan for clients. (See WAC 388-820-560 through 388-820-580.)

     "Individual with community protection issues" means a client identified by DDD as needing one or more of the following criteria:

     ((•)) (1) The person has been convicted of or charged with a crime of sexual violence as defined in chapter 71.09 RCW, including, but not limited to, rape, statutory rape, rape of a child, and child molestation;

     ((•)) (2) The person has been convicted of or charged with acts directed towards strangers or individuals with whom a relationship has been established or promoted for the primary purpose of victimization;

     ((•)) (3) The person has been convicted of or charged with a sexually violent offense and/or predatory act, and may constitute a future danger;

     ((•)) (4) The person has not been convicted and/or charged, but has a history of stalking, sexually violent, predatory, and/or opportunistic behavior which demonstrates a likelihood to commit a sexually violent and/or predatory act based on current behaviors that may escalate to violence;

     ((•)) (5) The person has committed one or more violent crimes, such as murder, attempted murder, arson, first degree assault, kidnapping, or use of a weapon to commit a crime.

     "Initial assessment" means a written evaluation that identifies a client's needs upon entry into crisis diversion services.

     "Instruction" means goal-oriented teaching that is designed for acquiring and enhancing skills.

     "ISP" refers to the individual service plan for clients. (See WAC 388-820-520 through 388-820-550.)

     "Nursing assistant" means a person who is registered or certified by department of health under chapter 18.88A RCW. A nursing assistant performs certain nursing care tasks that are delegated by a registered nurse for a specific client in authorized settings. (See chapter 246-841 WAC for more details.)

     "Regional support network (RSN)" means a county, combination of counties or other member entities under contract with DSHS mental health division (MHD). These RSNs administer all mental health service activities within their jurisdiction, using available resources. (See WAC 388-865-200 for details.)

     "Reprisal" means any negative action taken as retaliation against an employee.

     "Residential service" means client services offered by certified service providers.

     "Secretary" means the secretary of the department of social and health services or the secretary's designee.

     "Service provider" means an agency certified by and contracted with DDD to provide residential services to clients. Also refers to state operated living alternative (SOLA) program.

     "Severity" means the seriousness of an incident. This is determined by the extent to which a client's physical, mental, or psychosocial well-being is or may be compromised or threatened.

     "SSP" (state supplemental payment) means DSHS cash assistance program for certain DDD-eligible clients receiving SSI (Supplemental Security Income). (See chapter 388-827 WAC for details.)

     "Support" means assistance as requested or needed by a client, based on their abilities, needs, and goals.

     "Supported living" means residential services provided to clients living in their own homes, which are owned, rented, or leased by the clients or their legal representatives. (See WAC 388-820-080 for more details.)

     "Trust account" means a bank account containing two or more clients' funds where the service provider has the authority to make deposits and withdrawals.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-020, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-020, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-020, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 86-08-003 (Order 2349), § 275-26-020, filed 3/20/86; 83-05-017 (Order 1945), § 275-26-020, filed 2/9/83.]

     (1) Supported living services;

     (2) Group home services; or

     (3) Services provided in the group training home.

     Residential services must follow the requirements outlined in this chapter.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-030, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-030, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-022, filed 8/9/91, effective 9/9/91. Statutory Authority: RCW 34.05.220 (1)(a) and 71.12.030 [71A.12.030]. 90-04-074 (Order 2997), § 275-26-022, filed 2/5/90, effective 3/1/90. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), § 275-26-022, filed 2/9/83.]

     (((1))) (a) The client's own home;

     (((2))) (b) Group homes; or

     (((3))) (c) The group training home.

     (2) Residential services must be located in a residential neighborhood within reasonable distance of necessary resources, unless a client chooses to live in a remote area. Resources include stores, banks, laundromats, churches, job opportunities, and other public services.

     (a) Exception: Group homes certified prior to 1983 do not need to follow this requirement.

     (b) Exception: Clients who receive community protection services may not need to follow this requirement.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-050, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-050, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-060, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), § 275-26-060, filed 2/9/83.]

     (1) A single person dwelling that is maintained by the service provider; or

     (2) The client's own home.

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     (1) Receive residential services outlined in this chapter; or

     (2) Have an agreement with the service provider to purchase residential services using SSP funds.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-060, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-060, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-070, filed 8/9/91, effective 9/9/91. Statutory Authority: Chapter 72.33 RCW. 83-05-017 (Order 1945), § 275-26-070, filed 2/9/83.]

     For clients who receive more than forty hours of residential service per month.

     (((1))) (2) When clients receive more than forty hours of residential services per month, the service provider must ensure that the following physical and safety requirements are met for the client:

     (a) A safe and healthy environment;

     (b) Accessible telephone equipment;

     (c) An evacuation plan developed and practiced with the client;

     (d) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

     (e) A safe storage area for flammable and combustible materials;

     (f) Unblocked exits;

     (g) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms;

     (h) A flashlight or a nonelectrical light source in working condition; and

     (i) Basic first-aid supplies.

     For clients who receive forty hours or less of residential service per month.

     (((2))) (3) When clients receive forty hours or less of residential services per month, at least once every six months, the service provider must ensure the following physical safety requirements are met:

     (a) A safe and healthy environment;

     (b) An entrance and/or exit that does not rely solely upon windows, ladders, folding stairs, or trap doors;

     (c) A safe storage area for flammable and combustible materials;

     (d) Unblocked exits; and

     (e) A working smoke detector, with a light-alarm for clients with hearing impairments, located close to sleeping rooms.

     (((3))) (4) The following supports are also offered to clients who receive forty hours or less of residential services. These clients may choose not to participate in meeting these requirements. This choice must be documented by the service provider, as per WAC 388-820-100. The supports offered include:

     (a) Accessible telephone equipment;

     (b) An evacuation plan developed and practiced with the client;

     (c) A flashlight or a nonelectrical light source in working condition; and

     (d) Basic first-aid supplies.

     For all clients:

     (((4))) (5) The service provider must ensure that documentation is kept, showing that physical safety requirements are met. The client may independently document that these requirements are met as long as the client's IISP shows this involvement.

     (((5) Residential services must be located in a residential neighborhood within reasonable distance of necessary resources, unless a client chooses to live in a remote area. Resources include stores, banks, laundromats, churches, job opportunities, and other public services.

     (a) Exception: Group homes certified prior to 1983 may not follow this requirement.

     (b) Exception: Clients who receive community protection services may not follow this requirement.))

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-070, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-070, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-072, filed 8/9/91, effective 9/9/91.]

     (2) Service providers must assist clients so that the water temperature in their household is maintained below one hundred and twenty degrees Fahrenheit.

     (3) Service providers must check the water temperature when the client first moves into the household and at least once every six months from then on. Note: The water temperature is best measured two hours after substantial hot water usage.

     (4) The service provider must document compliance with this requirement.

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     (2) Group homes must have a contract with DDD.

     (3) The service provider must ensure that group homes comply with all applicable licensing regulations.

     (((3))) (4) Group homes provide residential services to two or more clients who are unrelated to the provider.

     (((4))) (5) Clients who live in group homes pay costs of room and board from their own financial resources. (See WAC 388-820-120 for additional information.)

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-090, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-090, filed 9/20/99, effective 9/20/99. Statutory Authority: Chapters 18.88A and 71A.12 RCW. 96-10-076 (Order 3978), § 275-26-076, filed 5/1/96, effective 6/1/96.]

     (a) Physical and safety requirements, as outlined in WAC 388-820-070(((2)))(3); and

     (b) Health services under WAC 388-820-690.

     (2) Documentation must include the following:

     (a) A description of events relating to the client's refusal to participate in these services;

     (b) A plan to inform the client of the benefits of these services;

     (c) A description of the service provider's efforts to give the services to the client; and

     (d) Any health or safety concerns that the refusal may pose.

     (3) The service provider must review this documentation with the client at least every six months. The client or client's guardian must sign the documentation after reviewing it.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-100, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-100, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-087, filed 8/9/91, effective 9/9/91.]

     (2) DSHS must require a client to share the cost of services when mandated by federal or state statute or regulation.

     (3) Clients funded through SSP may purchase services through a separate agreement with the service provider.

     (4) The service provider must inform DSHS when the client requires additional supports.

     (a) The service provider must submit a written request with justification for additional service hours.

     (b) DSHS may approve and provide payment for additional expenses or services.

     (c) The service provider must retain a copy of department ((approval)) response.

     (((4))) (5) For a client who is receiving group homeservices and support:

     (a) The client must pay for cost of care or services from earnings or other financial resources. Clients receiving SSI are responsible only for the cost of room and board.

     (b) DSHS may pay for these services only after a client has used his or her own financial resources.

     (c) When a client's guardian or legal representative controls the client's income, estate, or trust fund, ((they)) he or she must reimburse the service provider as described in WAC 388-820-120.

     (((5))) (6) Clients receiving supported living services must pay for their own housing, utilities, food, clothing, and other personal and incidental expenses from earnings and other financial resources.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-120, filed 10/26/01, effective 1/1/02; 99-19-104, recodified as § 388-820-120, filed 9/20/99, effective 9/20/99. Statutory Authority: RCW 71A.12.080. 91-17-005 (Order 3230), § 275-26-107, filed 8/9/91, effective 9/9/91.]

     (2) Provisional certification may not exceed one hundred eighty days.

     (3) At the end of provisional certification:

     (a) If the service provider has complied with certification requirements, DSHS may approve the service provider for regular certification.

     (b) If the service provider has not complied with all certification requirements, DSHS must revoke the service provider's certification and terminate the contract.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-230, filed 10/26/01, effective 1/1/02.]

     (1) Service providers must have these written statements approved by DDD:

     (a) A mission statement;

     (b) Program description and admission criteria;

     (c) An organizational chart and description showing all supervisory relationships; and

     (d) Definition of staff roles and responsibilities, including the person designated to act in the absence of the administrator.

     (2) Service providers must also have these policies and procedures approved by DDD:

     (a) ((Background checks, as required under chapter 388-146 WAC;

     (b) Client confidentiality and release of information;

     (c))) Client rights, ((which must include information on how to report suspected abuse, neglect, exploitation, and mistreatment;

     (d))) including a client's right to file a complaint or suggestion without interference;

     (b) Client grievance procedures((, including a client's right to file a complaint or suggestion without interference;

     (e) Protection of client's financial interests, including management of client accounts, if applicable;

     (f) Medication management, administration, and assistance;

     (g)));

     (c) Information on how to report suspected abuse, neglect, exploitation, and mistreatment;

     (d) Plans for responding to missing persons; client emergencies, including access to medical, mental health, and law enforcement resources; and natural or other disasters;

     (((h))) (e) Notification of client's guardian and/or relatives in case of emergency; and

     (((i))) (f) Methods used for soliciting client input and feedback on services and support received.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-260, filed 10/26/01, effective 1/1/02.]

     (2) Clients must have immediate access to staff, or the means to contact staff, at all times: Twenty-four hours a day, seven days a week.

     (3) A service provider must provide adequate staff within contracted ((funds)) hours to administer the program and meet the needs of the clients.

     (4) A service provider must have other staff available, as specified by the service provider's contract with DSHS.

     (5) Each group home must maintain staffing that complies with:

     (a) Boarding home or adult family home licensing requirements under chapter 388-78A or 388-76 WAC, respectively; and

     (b) Contract requirements with the division of developmental disabilities.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-290, filed 10/26/01, effective 1/1/02.]

     (2) Clients placed in crisis diversion services must not be involved in the instruction and support of other clients.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-300, filed 10/26/01, effective 1/1/02.]

     (4) Clearances must be renewed as specified by DDD)) Service providers must obtain background checks from DSHS for all administrators, employees, volunteers and subcontractors showing that there are no records prevent individuals from working with clients.

     (2) Before administrators, employees, volunteers or subcontractors may have unsupervised access to clients, the service provider must have a background check report from DSHS. This report must indicate that the individual has no disqualifying records that prevent him or her from working with clients.

     (3) In certain situations, administrators employees, volunteers or subcontractors must not work alone with clients unless they are directly observed by staff authorized to have unsupervised access to clients. These situations are:

     (a) The service provider has not yet received a DSHS response for a background check request;

     (b) DSHS has disqualified the individual based on background check information; or

     (c) The individual is awaiting FBI clearance and does not have provisional clearance from their employer under WAC 388-06-0500 through 388-06-0540.

     (4) Background checks must be renewed at least every thirty-six months for each administrator employee, volunteer or subcontractor of a contracted service provider.

     (5) Service providers must follow the requirements of RCW 43.43.830 and 74.15.030.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-310, filed 10/26/01, effective 1/1/02.]

     (1) Exhibit job-related competency and the ability to make independent judgments;

     (2) Have a high school diploma or GED equivalent, unless the employees were hired before ((1983)) September 1, 1991;

     (3) Be at least eighteen years of age when employed as a direct care staff, or at least twenty-one years of age when employed as an administrator; and

     (4) Treat ((a client)) clients with dignity and consideration, respecting the ((client's)) clients' civil and human rights at all times.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-320, filed 10/26/01, effective 1/1/02.]

     (1) Before the employee works alone with clients, the service provider must explain the following to the employee:

     (a) The current instruction and support ((plan for the employee's)) plans of the clients with whom the employee works;

     (b) Emergency procedures for clients;

     (c) The DSHS-approved policy on abuse and neglect; and

     (d) Client confidentiality.

     (2) Within the first four weeks of employing a staff person, the service provider must provide training that includes:

     (a) The service provider's mission statement;

     (b) Policies and procedures; and

     (c) On-the-job training.

     (3) Additional training within the first six months must include:

     (a) First aid/CPR;

     (b) ((Bloodborne)) Blood-borne pathogens with HIV/AIDS information; and

     (c) Client services.

     (4) Each employee must keep first aid/CPR certification and ((bloodborne)) blood-borne pathogens training current.

     (5) The service provider must document orientation and training activities.

     (6) Group homes must also meet the training requirements mandated by the licensing requirements specified ((by DSHS)) in chapter 388-78A WAC.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-330, filed 10/26/01, effective 1/1/02.]

     (2) If the service provider is a nonprofit organization, ((administrators must be evaluated annually by their supervisor or by)) the organization's governing board, must give written performance reviews for administrators every twenty-four months.

     (3) If the service provider is a for-profit organization, owners are not required to have performance reviews.

     (4) If the service provider is a governmental agency, administrators are evaluated by their supervisor.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-340, filed 10/26/01, effective 1/1/02.]

     (2) The staff-coverage schedules must be approved at the following times:

     (a) Before certification review takes place;

     (b) When household configuration changes affect ((funding; and)) staff coverage; or

     (c) When additional staffing is requested.

     (3) Staff-coverage schedules may be requested by DDD at any time.

     (4) Each service provider must retain copies of the approved staff-coverage schedules.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-350, filed 10/26/01, effective 1/1/02.]

     (2) Service ((provider needs to)) providers must keep certain information in client records to fulfill DSHS requirements. The client's records must include, but not be limited to, the following:

     (((1))) (a) The client's name, address, and Social Security number.

     (((2))) (b) The name, address, and telephone number of the client's relative, guardian or legal representative.

     (((3))) (c) Copies of legal guardianship papers, if any.

     (((4))) (d) Client health records, including:

     (((a))) (i) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

     (((b))) (ii) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

     (((c))) (iii) Written documentation that the health care service providers' instructions have been followed; and

     (((d))) (iv) A record of major health events and surgeries when known.

     (((5))) (e) A copy of the client's individual service plan (ISP).

     (((6))) (f) The client's individual instruction and support plan (IISP), including:

     (((a))) (i) Instruction and support activities for each client as a basis for review and evaluation of client's progress;

     (((b))) (ii) Semiannual review of the IISP;

     (((c))) (iii) Consultation with other service providers and other interested persons;

     (((d))) (iv) IISP revisions and changes; and

     (((e))) (v) Other activities relevant to the client that the client wants included.

     (((7))) (g) Progress notes and incident reports on clients.

     (((8))) (h) The client's financial records for funds managed by the service provider, including:

     (((a))) (i) Receipts, ledgers and records of the client's financial transactions; and

     (((b))) (ii) Client's related bankbooks, checkbooks, bank registers, tax records and bank statements.

     (((9))) (i) Burial plans and wills.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-400, filed 10/26/01, effective 1/1/02.]

     (a) The client's name, address, and Social Security number.

     (b) The name, address, and telephone number of the client's relative, guardian or legal representative.

     (c) Progress notes and incident reports on clients.

     (2) Crisis diversion service providers other than those offering services in a client's own home have additional requirements. These service providers also must keep the following information in client records:

     (a) An initial assessment;

     (b) An crisis service plan;

     (c) Copies of legal guardianship papers, if any;

     (d) Client health records, including:

     (i) The name, address, and telephone number of the client's physician, dentist, mental health service provider, and any other health care service provider;

     (ii) Health care service providers' instructions about health care needed, including appointment dates and date of next appointment if appropriate;

     (iii) Written documentation that the health care service providers' instructions have been followed; and

     (iv) A record of major health events and surgeries when known.

[]

     (2) The service provider must assist clients in maintaining current, written property records when the clients receive forty hours or more a month of services. The record consists of:

     (((1))) (a) A list of items with a value of at least twenty-five dollars that the client owns when moving into the program;

     (((2))) (b) A list of personal possessions with a value of seventy-five dollars or more per item once the client is receiving services;

     (((3))) (c) Description and identifying numbers, if any, of the property;

     (((4))) (d) The date the client purchased the items after moving into the program;

     (((5))) (e) The date and reason for addition or removal from the record; and

     (((6))) (f) The signature of the staff or client making the entry.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-410, filed 10/26/01, effective 1/1/02.]

     (2) In addition, an ISP meeting must be held and a new ISP developed with the client at least every two years, under RCW 71A.18.010. The meeting must be held in the client's home unless requested otherwise by the client.

     (3) A client may request a review of the ISP at any time.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-550, filed 10/26/01, effective 1/1/02.]

     (1) An initial assessment plan within forty-eight hours of placement; and

     (2) A crisis service plan within seven days of placement.

[]

     (2) The IISP must be based on the goals of the individual service plan (ISP), reflect the client's preferences, and have the client's agreement.

     (3) The IISP identifies activities and opportunities that promote one or more of the following client services:

     (a) Health and safety;

     (b) Personal power and choice;

     (c) Positive recognition by self and others;

     (d) Integration in the physical and social life of the community;

     (e) Positive relationships; and

     (f) Competence and self-reliance.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-560, filed 10/26/01, effective 1/1/02.]

     Note: In this situation, service providers are not necessarily considered managers of the client's funds.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-600, filed 10/26/01, effective 1/1/02.]

     Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 01-22-020, filed 10/26/01, effective 1/1/02)

WAC 388-820-650   What documentation must service providers keep to protect a client's financial interests?   Service providers must keep certain documentation for the part of funds they manage for clients. This protects clients' financial interests.

     (1) Documentation for bank and cash accounts must include monthly reconciliation of bank and cash accounts that are verified and initialed by a second party who did not make or assist in the transaction.

     (2) Other documentation that a service provider must keep for client financial transactions include:

     (a) Monthly bank statements and reconciliation;

     (b) Checkbook registers and bankbooks;

     (c) Deposit receipts;

     (d) Receipts for purchases over twenty-five dollars((, or as specified in the financial plan));

     (e) Any itemized subsidiary ledgers showing deposits, withdrawals, and interest payments to individual clients; and

     (f) A control journal for trust accounts.

     (3) Other documentation that a service provider must keep for client cash transactions include:

     (a) A detailed ledger signed by the person who withdrew any of the client's money;

     (b) Monthly reconciliation to the cash amount;

     (c) Detailed accounting of the money received on behalf of the client, such as cash received from writing checks over the purchase amount, and a list of where the money was spent; and

     (d) Receipts for purchases over twenty-five dollars where service provider staff withdrew the money.

     (4) Service providers must notify DSHS when the client:

     (a) Receives services under a CAP (community alternative program) waiver; and

     (b) Has an account that reaches three hundred dollars less than the maximum amount allowed by federal or state law.

     Note: CAP-waiver is defined under WAC 388-825-170.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-650, filed 10/26/01, effective 1/1/02.]

     (a) Accessing health, mental health, and dental services; and

     (b) Medication management, administration and assistance.

     (2) For clients who receive an average of thirty hours or more of service per month or are placed in the diversion services, the service provider must:

     (a) Maintain health records;

     (b) Assist the client in arranging appointments with health professionals;

     (c) Monitor medical treatment prescribed by health professionals;

     (d) Communicate directly with health professionals when needed; and

     (e) Ensure that the client receives an annual physical and dental examination unless the appropriate medical professional gives a written exception. Crisis diversion service providers are exempt from this requirement.

[Statutory Authority: Title 71A RCW. 01-22-020, § 388-820-690, filed 10/26/01, effective 1/1/02.]

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